Dr Ted Hughes: Immunisation, Cook Islands’ silent triumph

Probably by the year’s end a vaccination for Covid-19 will be available, most likely resulting from a collaboration between Oxford University and Astra-Zeneca. Potentially such a vaccine will end the Covid-19 crisis worldwide, if people agree to be vaccinated.

Last year a widespread measles epidemic occurred in New Zealand because the vaccination rate had slipped too low. In Samoa the measles epidemic killed more than 100, mainly children under five years old.

But in Cook Islands with more than 180,000 mainly New Zealand visitors, there was no measles epidemic – not even a single measles case at all. The reason was that health ministry Te Marae Ora had vaccinated 100 per cent of children under 1, and more than 94 per cent of those aged 1-5 years.

Another Te Marae Ora vaccination success story is that the recent mumps outbreak in New Zealand did not spread to Rarotonga, due to our high vaccination rate.

When the protection is this good, public health is invisible and few in Rarotonga realise that great potential disasters have been avoided by Te Marae Ora’s successful strategy.

My mother was born in Areora village in Atiu in 1933. In those days horses were used for most agriculture all over the Cook Islands, where we would use tractors and ATVs nowadays.

Horse manure is full of the tetanus germ so mum, who was a teacher, told me she watched many little children die in Atiu from tetanus. It was as a result of minor foot trauma getting infected, as shoes were often not available to children then. The best treatment for tetanus is to avoid it by giving children tetanus vaccinations.

Tetanus still kills in New Zealand in older adults, unvaccinated in childhood, and I have known of recent deaths in New Zealand and due to stonefish envenomation here, as sadly occurred a few years ago in an older patient who presumably was not vaccinated in childhood as children are now.

The intensive care services now available in Rarotonga Hospital mean death from tetanus is mostly avoidable here now – but the treatment is still arduous. It involves being placed on a ventilator before transferring to New Zealand for probably two to eight weeks on a ventilator in New Zealand in an Intensive Care Unit, with considerable risks, then a period of weeks to months of convalescence in rehabilitation units in New Zealand.

When it works well, public health is invisible. Vaccinations can make tetanus, measles, mumps and maybe even Vovid-19 in the end virtually invisible.